When you ask dental professionals what they see as the most important recent development in dentistry, many will tell you it’s magnification. After all, dentists can’t treat what they can’t see.
Thanks to magnification in dentistry, we now know that disasters in waiting—from open margins to accessory root canals—were being missed because they were simply not visually detectable. But in addition to improving diagnostic and treatment accuracy, magnification technologies have also proven to be game changers in today’s push for minimally invasive dentistry, making possible things like microsurgery and early caries identification.
Among the more likely types of magnification systems found around dental practices are loupes. Many key opinion leaders in dentistry consider these binoculars as the absolute minimum requirement for clinicians.
Loupes are available in two iterations. Lightweight and affordable Galilean loupes offer a large field of view with magnification power between 2.0 x and 5.5 x. Prismatic, or Keplerian, loupes sport magnifications of 4.0 x-8.0 x, with greater depth of field, higher resolution and longer telescopes than Galilean loupes.
Thanks to steep declination angles, operators need only look down, rather than contorting their necks and backs into uncomfortable positions. Many of them are also equipped with illumination to further enhance visual acuity. Such attributes make loupes a smart ergonomic investment.1Inside Dentistry. Enhanced Visualization with Lens Systems: Loupes and Microscopes. Available here. Accessed September 11, 2018.
And as clinicians age, the benefits of magnification only increase.
Dental Operating Microscopes
While loupes are regarded as a basic necessity in today’s practices, dental operating microscopes (DOM) are certainly the next step up. Especially in specialties such as endodontics and periodontics, DOMs — standalone units that offer a magnification range of 4 x-25 x — are setting a high bar in diagnostics and treatment delivery. In fact, increasing numbers of practitioners say that they can’t perform surgeries without them.
In endodontics, DOMs are becoming invaluable in both nonsurgical applications and in root-end surgeries. They help clinicians identify cracks, fractures and calcifications, and locate accessory canals.2Endodontics. The Dental Operating Microscope in Endodontics. Available here. Accessed September 11, 2018.
In fact, in one study, detection of second mesiobuccal canals in maxillary molars was found to be 90% with a dental operating microscope, used in conjunction with ultrasonics, and only 52% without visual aids.3Alaçam T, Tinaz AC, Gene Ö, Kayaoglu G. Second mesiobuccal canal detection in maxillary first molars using microscopy and ultrasonics. Aust Endod J. 2008;34:106–109.
And when it comes to periodontal microsurgery4Hegde R, Sumanth S, Padhye A. Microscope-enhanced periodontal therapy: a review and report of four cases. J Contemp Dent Pract. 2009;10:E088–96. or eliminating procedural errors in restorative dentistry, the high magnification provided by DOMs is hard to beat.5Henry Schein. New Clinical Innovations and The Benefit of Magnification to Ensure Predictable Posterior Composite Restorations—Part 2. Available at: https://henryschein.com.au/documents/PDFs/IntDent/1_ID-AUS_van%20der%20Vyver_2.pdf. Accessed September 11, 2018.
To boost success rates even higher, high-resolution digital cameras can be attached to microscopes, allowing either still or video images to be projected onto a screen or monitor for patient education and treatment plan acceptance.
Intraoral cameras are quickly becoming go-to equipment for many modern practices. Some can detect minutia such as early caries and oral cancers. They can also capture headshots, which can help with patient documentation.
Instead of clinicians contorting their bodies to see into the depths of an oral cavity armed only with a mouth mirror and explorer, they can use these wand-like cameras to capture intraoral stills and videos in high resolution.
The Upshot of Magnification in Dentistry
Use of any of these devices, can involve a bit of a learning curve. But isolation systems such as Isolite, can help. Its flexible, patient-friendly, transparent mouthpiece is illuminated and offers soft-tissue retraction, making it a visual aid in its own right. And, thanks to its continuous suction feature, it can keep moisture and fogging in check, further optimizing clarity for magnification.
Overall, the benefits of using visual technologies are said to vastly outweigh the effort it takes to learn how to use them. Contemporary clinicians can’t go wrong in adding any of these kinds of visual aids to their armamentariums.